P973: REAL-WORLD STUDY ON ADOPTION OF STANDARD OF CARE (SOC) FOR FRONTLINE TRANSPLANT-ELIGIBLE MULTIPLE MYELOMA (FLTEMM) PATIENTS BETWEEN 2017 AND 2020/2021 ACROSS FRANCE, GERMANY, SPAIN, AND ITALY
Authors: K. Weisel, A. Wadlund, G. Gungor, E. Dergarabetian, C. Pacheco, N. Masurkar, P. Rodriguez-Otero
Journal: HemaSphere (2022)

Background: Newer therapies for frontline transplant-eligible multiple myeloma (FLTEMM) are underway, but an accurate and updated overview of standard MM treatment management is lacking. Repeated analyses and real-world data are warranted to describe current MM standard of care (SoC), treatment lines, and patient clinical outcomes in daily practice. Aims: This non-interventional, cross-sectional, retrospective observational database study described the current SoC for FLTEMM patients in France, Germany, Spain, and Italy, and recorded the evolution in regimen adoption in distinct elements of frontline treatment (induction, consolidation, and maintenance) during 2017-2020/2021. Methods: Clinical information on ongoing (population I) or previous (population II) FLTEMM patients was extracted from the Cancerology database. The primary objective was to describe the treatment regimen considered current SoC for FLTEMM management in all four countries using study population I, and to study the evolution in the use of different regimens in induction phase using study population II. The secondary objective was to describe clinical outcomes, including best tumor response and minimal residual disease (MRD) status, associated with each induction regimen in study population II. Results: In study populations I and II, the median (min, max) age of the patients at induction initiation was 59.0 (35.0, 86.0) and 60.0 (23.0, 80.0) years and 62.9% (227/361) and 64.8% (287/443) patients were male, respectively. In study population I, the most common induction regimens were bortezomib/lenalidomide/dexamethasone (VRd) in France (75.3%, 33/44) and Spain (44.1%, 53/120), bortezomib/thalidomide/dexamethasone (VTd) in Italy (65.2%, 76/116), and others in Germany (58.9%, 48/81) (including daratumumab-based [19.8%, 16/81] or not). Maintenance was ongoing or planned for 78.3% (34/44), 62.3% (51/81), 65.2% (78/120), and 61.4% (71/116) patients in France, Germany, Spain, and Italy, respectively. Among study population I patients on an ongoing maintenance regimen, lenalidomide was received by 99.6% (20/20) patients in France, 86.8% (34/40) in Germany, 80.2% (45/56) in Spain, and 90.7% (30/33) in Italy. In study population II, VRd use as 1L induction increased from 27.0% (10/36) in 2017 to 65.7% (12/18) in 2019 in France and was relatively low in Germany, Spain, and Italy. The most common 1L induction regimen in Germany was VCd, but its use decreased from 85.2% (31/37) in 2017 to 64.1% (24/38) in 2019. VTd was the most common 1L induction in Spain and Italy, but its use declined from 58.3% (16/27) and 72.4% (34/47) in 2017 to 17.3% (4/22) and 52.8% (19/36) in 2019, respectively. In total, 37.5% (166/443) study population II patients achieved at least a complete response, which was the highest for those on VRd (59.2% versus 34.3% for VTd, 33.4% for VCd, and 33.7% for other non-daratumumab-based regimens, respectively). In total, 42.5% (188/443) study population II patients were tested for MRD status and 18.2% (81/443) were found negative. MRD testing rate varied from 26.2% in France to 14.8% in Germany, 84.4% in Spain, and 47.7% in Italy. Summary/Conclusion: The use of bortezomib triplets in induction varied markedly over time and between selected countries. Despite not being approved by the European Medicines Agency specifically for FLTEMM patients, VRd use tended to increase with time in France and to a lesser extent in Spain and Italy in this population.